Jurnal Gizi dan Dietetik Indonesia Available online at: https://ejournal.
id/index.
php/IJND (Indonesian Journal of Nutrition and Dietetic.
Vol 12.
Issue 5, 2024:387-396 p-ISSN 2303-3045 e-ISSN 2503-183X DOI: https://dx.
org/10.
21927/ijnd.
Low dietary diversity is associated with stunting among children aged 823 months in stunting locus area.
Yogyakarta Putri Lestari1.
Winda Irwanti1.
Hastrin Hositanisita1.
Yhona Paratmanitya1.
Eka Nurhayati2.
Yi Yi Lee3.
Siska Ariftiyana1.
Herwinda Kusuma Rahayu1* 1Department of Nutrition.
Faculty of Health Sciences.
Universitas Alma Ata Yogyakarta 55183.
Indonesia 2Alma Ata Graduate School of Public Health.
Faculty of Health Sciences.
Universitas Alma Ata Yogyakarta 55183.
Indonesia 3Division of Nutrition and Dietetics.
IMU University.
Kuala Lumpur.
Malaysia *Correspondence: herwinda@almaata.
ABSTRAK
Latar Belakang: Stunting adalah kondisi balita mengalami gagal tumbuh dan kembang yang disebabkan oleh kekurangan gizi kronis dan penyakit infeksi berulang terutama pada 1.
hari pertama kehidupan sehingga anak lebih pendek.
Keanekaragaman pangan diartikan sebagai konsumsi berbagai jenis kelompok bahan makanan yang dapat memenuhi kebutuhan zat gizi bagi kesehatan yang optimal.
Pola konsumsi makanan yang beranekaragam pada anak usia 6Ae23 bulan masih rendah Tujuan: Mengetahui hubungan keanekaragaman pangan individu dengan kejadian stunting pada anak usia 8-23 bulan di Kecamatan Pajangan Kabupaten Bantul Yogyakarta.
Metode: Jenis penelitian ini adalah penelitian kuantitatif observasional dengan desain cross Variabel independen keanekaragaman pangan dan variabel dependen yaitu Teknik pengambilan sampel menggunakan purposive random sampling dengan total sampel sebanyak 167 anak usia 8-23 bulan dengan ibu/pengasuh sebagai responden.
Pengambilan data dilakukan dengan cara obeservasi dan wawancara terstruktur menggunakan kuesioner.
Pengambilan data meliputi pengukuran antropometri, food recall 24jam, dan kuesioner Individual Dietary Diversity Score (IDDS).
Uji statistik bivariat menggunakan chi-square.
Hasil: Hasil penelitian menunjukkan bahwa prevalensi stunting adalah 32,3% dan 54,5% anak tidak memenuhi keberagaman makanan minimum.
Terdapat hubungan yang signifikan antara keberagaman makanan pada pemberian makanan pendamping dan stunting .
=0,005.
OR=2,558.
95%CI= 1,422-4,.
Selain itu, faktor lain yang berhubungan dengan keberagaman makanan adalah usia anak, status pekerjaan ibu, pendidikan ayah, pekerjaan ayah, dan pendapatan keluarga.
Kesimpulan: Terdapat hubungan antara keberagaman pangan dengan kejadian stunting pada anak usia 8-23 bulan di Kecamatan Pajangan.
Kabupaten Bantul.
Yogyakarta.
Strategi peningkatan keberagaman pangan pada pemberian makanan pendamping ASI diperlukan untuk mencegah terjadinya malnutrisi pada anak.
KATA KUNCI: IDDS.
MP-ASI.
Copyright A 2024 by Author.
Published by Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetic.
Alma Ata University Press.
This is an open-acces distributed under the CC BY-SA 4.
0 License .
ttps://creativecommon.
org/license/by/4.
388 Putri Lestari.
Winda Irwanti.
Hastrin Hositanisita,et al.
JGDI (IJND).
Vol 12 Issue 5 2024: 387-396
ABSTRACT
Background: Stunting is impaired growth and development that children experience, caused by poor nutrition during 1000 days of life.
Dietary diversity is one of the core indicators for assessing diet quality and adequacy of complementary feeding.
Objectives: This study aimed to analyzed the relationship between dietary diversity and stunting among children aged 8-23 months in Pajangan District.
Bantul Regency.
Yogyakarta.
Methods: This was a quantitative observational cross-sectional study.
Purposive random sampling was used to recruit a total of 167 children aged 8-23 months with their mothers/ caregivers as respondents.
Individual dietary diversity was assessed by minimum dietary diversity with the consumption of 5 or more food groups of the total 7 food groups.
Logistic regression, chi-square test, and descriptive statistics were used for data analysis.
Results: Results showed that prevalence of stunting was 32.
3% and 54.
5% of children did not meet the minimum dietary diversity.
There was a significant relationship between dietary diversity on complementary feeding and stunting .
=0.
OR=2.
95%CI= 1.
Furthermore, other factors related to dietary diversity were childAos age, mother's employment status, father's education, fatherAos employment, and family income.
Conclusions: There was a relationship between dietary diversity and stunting among children aged 8-23 months in Pajangan District.
Bantul Regency.
Yogyakarta.
Strategy to improve dietary diversity on complementary feeding are needed to prevent child malnutrition.
KEYWORD: dietary diversity.
complementary feeding.
Article info:
Article submitted on June 11, 2024
Articles revised on July 187, 2024
Articles received on September 9, 2024
INTRODUCTION
Stunting is a condition of children experiencing growth and development failure caused by chronic malnutrition, especially in the first 1,000 days of life, where children become shorter.
According to the World Health Organisation (WHO), a child is considered stunted when the height-for-age z-score is less than minus two standard deviations based on growth standards.
Stunting can have serious impacts, including short-term related to morbidity and mortality in toddlers, medium-term related to low intelligence and cognitive abilities, and long-term related to the quality of human resources and degenerative disease problems in adulthood.
Globally, about one in four children under the age of five are stunted, and Indonesia is ranked fifth among southeast Asian countries with highest stunting prevalence .
Indonesian nutritional status survey in 2022 showed that the prevalence of stunting in Indonesia was 21.
Meanwhile, the prevalence of stunting in Yogyakarta Province 4% and Bantul Regency was the second highest stunting prevalence from five district in Yogyakarta Province with stunting prevalence 9% .
Stunting is caused by two direct causes: low nutrient intake and health status.
Research shows that stunting is strongly associated with Individual dietary diversity in children.
A child's dietary diversity score of less than four is 16.
times more likely to be stunted than a child with a good dietary diversity score.
There is no single food that contains complete nutrition for children older than six months, therefore consuming a variety of foods is expected to meet these nutrient needs.
Based on the Basic Health Research 2018, the proportion of diverse food consumption in children 6-23 months in Indonesia was 46.
with diverse food is measured based on 4 of the 7 types of food groups.
Parents play an important role in development child feeding practice.
Research shows that unresponsive feeding practices such as pressuring children to eat and using food as a reward are associated with children refusing to eatand higher levels of picky eater behavior and Low dietary diversity is associated with stunting among children aged 8-23 monthsA 389 lower food attraction and food intake.
There is a few research exists on the impact of picky eating on dietary diversity, but picky eaters have been shown to have less diversity and variety at 24-36 months or eat less of different types of food.
Dietary diversity is also reflected in people's ability to buy food.
Low economic conditions have a risk of stunting because it can illustrate the family's ability to fulfil nutritious food intake.
Research shows that children from severely and moderately food insecure households have a higher risk of stunting than children living in food secure households.
According to the Food and Agriculture Organization of the United Nations (FAO), the Dietary Diversity Score (DDS) method is a simple method that is easy to implement and very effective in measuring differences in food consumption at the household and individual levels.
Diversity consumption is assessed using the IDDS Results of the Food and Nutrition Vigilance System in Bantul District 2020 showed that one of the villages in Pajangan District.
Guwosari Village was categorized as moderate risk in food insecurity areas.
This study aimed to analyzed the relationship between dietary diversity and stunting among children aged 8-23 months in Pajangan District.
Bantul Regency.
Yogyakarta.
MATERIALS AND METHODS
This study was an observational quantitative research with a cross-sectional design.
Data collection was conducted in Pajangan District.
Bantul Regency.
Yogyakarta on children aged 623 months from December 2022 to March 2023.
Totally, 167 children aged 8-23 months were included in this study.
The sampling technique used was purposive random sampling.
Inclusion criteria were healthy children aged 8-23 months, had lived more than 3 months in the research area, and the children's mothers or caregivers who were willing to be research respondents in this Respondents who did not complete the questionnaire were excluded from the study.
Stunting was defined based on childrenAos height at a specific age or height for age.
Z-score was used to calculate the height for age indicator based on WHO growth guidelines.
Stunting consists of two categories: not stunted (-2.
0 SD)
and stunting (< -3.
0 SD to -2.
0 SD).
Height was taken using infant length board (Seca 417 infantomete.
to the nearest 1 mm.
Respondents were asked to report their children consumption in previous a day using multiple-pass 24-hours recall that adapted from Newcastle 85 study, along with food photo book published by Ministry of Health in 2014 to help respondents in estimating the food portion .
The IDDS form adapted from WHO and UNICEF in 2021 for were used for dietary diversity score measurement.
Dietary diversity scores were taken from eight food groups, consisting of cereals and tubers.
A-rich plant foods.
other fruits and vegetables.
animal meat.
milk and its products.
breast milk.
A score of 1 was given if the food group was consumed with a minimum food weight of 10 grams.
Furthermore, the dietary diversity score was categorized high if the score of IDDS Ou5 and low if <5 .
Relationship between dietary diversity and stunting was analyzed by bivariate analysis with chi-square test using 95% confidence level.
Ethical clearance was taken from Institutional Review Board of Research Ethics Commission of Alma Ata University Yogyakarta with number:
KE/AA/XII/10982/EC/2022.
RESULTS AND DISCUSSIONS
Characteristics of Respondents Based on Table 1, most of the children are aged 13-23 months .
5%) , more than half of them were male .
3%), majority of them .
were born with normal weight and 84.
4% of the children were exclusively breastfed.
Based on height-for-age, categorized as stunting.
The age of most parents ranged from 30-39 years old.
Most of the fathersAo and mothersAo education level was high school Most mothers' employment status was categorized as not working .
5%), while most fathers worked as private employees .
3%).
Household monthly income was mostly below the Bantul Regency Regional Minimum Wage of IDR 2,066,438.
There were 54 .
3%) stunted children in Pajangan Sub-district.
Bantul Regency, this prevalence was higher than national prevalence of stunting .
6%).
Fulfillment of minimum dietary diversity (MDD) is one of the 390 Putri Lestari.
Winda Irwanti.
Hastrin Hositanisita,et al.
JGDI (IJND).
Vol 12 Issue 5 2024: 387-396 priority programs to prevent stunting in children aged 6-23 months.
Results showed that 54.
5% of children aged 8-23 months had diverse dietary diversity consumption, this proportion was higher than dietary diversity score in Indonesia .
6%) .
Similar research results in Bogor in 2020 stated that more than half of children aged 6-23 months .
1%) had consumed 5 out of 9 types of food groups.
Another study in Sedayu Sub-district, also showed that 62.
4% of children consumed a diverse diet .
Table 1.
Characteristics of Children (N=.
Characteristics Age of Child 8-12 months 13-23 months Gender Male Female Birth Weight <2500 gram Ou2500 gram Exclusive Breastfeeding Yes Stunting Stunting Not stunting Minimum Dietary Diversity Diverse (IDDS Ou.
Not diverse (IDDS <.
Frequency .
ChildrenAos characteristic Maternal characteristic Mother's age <20 years 20-29 years 30-39 years 40-49 years Mother's Education Did not complete elementary school Elementary school Junior high school High school Diploma Undergraduate/ higher Mother's Occupation Farmer Laborer Private employee Civil servant / military / police Self-employed Housewife Paternal characteristic Father's age 20-29 years 30-39 years 40-49 years Ou50 years Father's education Did not complete elementary school Low dietary diversity is associated with stunting among children aged 8-23 monthsA 391 Characteristics Elementary school Junior high school High school Diploma Undergraduate/ higher Father's Occupation Farmer Factory laborer Daily Laborer Farm laborer Private employee Public Servant / Army/ Police Entrepreneur Not working Monthly Household Income <Regional Minimum Wages OuRegional Minimum Wages Frequency .
Source: Primary Data In this study (Figure .
, non-stunting children had the highest percentage of meet minimum dietary diversity (DDS=.
with an average score of The results of previous research on children aged 6-23 months showed a significant linear trend between the level of dietary diversity scores Stunting in complementary feeding and risk of stunting.
Increasing daily consumption of various food groups can reduce the risk of stunting in children .
Research in East Java also showed an association between high dietary diversity scores and low probability of stunting .
Not Stunting 48,1% 38,1% 23,0% 18,5% 14,2% 0,0% 0,0% 5,6% 0,9% Score 1
Score 2
21,2%
13,0%
7,4%
Score 3
5,6%
Score 4
Score 5
Score 6
2,7%
Score 7
1,9%
0,0%
Score 8 Figure 1.
Percentage of stunting by dietary diversity score Figure 2 showed that the highest percentage of food group consumption was cereals and tubers food group, this was due to rice was main commodity and staple food in Bantul District.
The results of this analysis was similar to several previous studies which state that the types of food most consumed by toddlers in Indonesia are cereals, roots, and tubers, where almost all children consume these food groups .
,29,.
In this study, most children consumed instant baby porridge.
Continuous feeding of instant baby porridge should be avoided due to preservatives contained .
This study showed that the difference in the percentage meat consumption between stunted and non-sunting children was only 5.
7%, but the difference in egg and milk consumption was quite far, at 13.
2% and 6%, respectively.
This could be because stunting children received information from health workers to consume more animal protein.
addition, one of the weaknesses in using DDS is that it only calculates the number of types of food 392 Putri Lestari.
Winda Irwanti.
Hastrin Hositanisita,et al.
JGDI (IJND).
Vol 12 Issue 5 2024: 387-396 groups consumed without considering the portion and amount eaten, so there is a possibility that the children consumed diverse foods but not in sufficient quantity.
Commercial infant formula is usually available as a milk powder that has to be reconstituted with water.
The instructions on the tin or carton for preparing the formula should be followed exactly to ensure that it is not too Stunting 96,3% concentrated or diluted.
Overconcentration can overload the infant with salts and protein, which can be dangerous, and overdilution can lead to malnutrition.
For example, children often drink
milk but the consistency is not measured by this Perhaps stunted children consume milk that's too watery, resulting in lower protein
Not Stunting 98,2% 83,2% 68,5% 73,5% 62,8% 55,6% 46,3% 36,3% 29,6% Breast Milk
Cereals and Nuts 59,3% 57,4% 44,2% 37,0% 32,7% Milk and dairy Animal meat
Eggs
41,6%
Vitamin A-rich Other fruits and fruits and Figure 1.
Percentage of stunting by food group Based on the results of chi-square analysis, there was a significant relationship between individual dietary diversity and stunting in Pajangan District.
Children who were not stunting 55 odds consumed consumed diverse diet.
This was similar to previous research where children who had non-diverse consumption patterns are at risk of stunting 3 times greater than children with diverse consumption patterns .
Table 2 showed an association between child age and dietary diversity.
Children aged 1323 months ate a more diverse diet .
=0.
OR=2.
In accordance with Sarait and Achadi's research.
MDD achievement was better in older children.
Children aged 18-23 months had 7 times chance of achieving MDD and children aged 12-17 months 1.
3 times, compared to infants aged 6-11 months.
As children get older, the food provided should be more diverse, nutritious and balanced, thus supporting the nutritional status and growth and development of children.
Proper nutrition management is associated with quality child nutrition, which in turn improves nutritional adequacy.
The results of the chisquare test showed an association between maternal employment status and children's dietary diversity (P-value = 0.
OR = 2.
Mothers who do not work tend to have children who consume non-diverse foods .
9%), while working mothers tend to have children who consume diverse foods .
7%).
The results of this study are in line with research in the Philippines which states that more children have adequate MDD in working mothers .
Hardinsyah mentioned that one of the impacts when mothers work is an increase in the food consumed quality by households .
The results of chi-square analysis showed that there was a relationship between father's education level and children's dietary diversity (P=value 0.
OR=
Fathers with less than 9 years of education are 4 times more likely to have children who consume non-diverse foods.
The results of this study are in line with Sirait and Achadi's research that fathers who have high education had 6 times chance of their children consumed Low dietary diversity is associated with stunting among children aged 8-23 monthsA 393 diverse foods .
A high school educational background is a relatively high education, so fathers can fulfil their role as head of the family.
The activities carried out are related to meeting the food and non-food needs of the family through income .
Table 2.
Factors related to childrenAos dietary diversity on complementary feeding (N=.
Characteristics ChildrenAos characteristic Age 8-12 months 13-23 months Gender Male Famale Nutritional status (Height for Ag.
Stunting Not stunting MotherAos characteristic Mother's Age <20 years 20-29 years Mother's Education Low High Mother's Occupation Not working Working FatherAos Age <33 years Ou33 years Fathers Education Low High Father Occupation Not working / farm laborer / factory / daily / selfemployed / farmer Private employee / civil servant / military / police Household Income <Regional Minimum Wages OuRegional Minimum Wages Not diverse Diverse P-value 95% CI In this study, fathers' occupations such as laborers, farmers and self-employed were expected to earn irregular income, which will affect the purchasing power of food and will affect children's growth.
Chi-square analysis showed that there was an association between father's occupation and children's dietary diversity.
Based on Table 2, it was known that fathers who had a fixed income such as private employees, civil servants, military and police tend to had 2.
4 times odd their children consumed diverse foods .
4%).
The results showed that there was a relationship between household income and children's dietary diversity.
Families with high 394 Putri Lestari.
Winda Irwanti.
Hastrin Hositanisita,et al.
JGDI (IJND).
Vol 12 Issue 5 2024: 387-396 income level had a 2.
5 times odds of their children consumed diverse diet.
The high household income can meet household needs, especially diverse food needs, so that toddler food intake is Household who have economic access and fulfillment of sufficient needs will affect the improvement in the quality of food consumption of household members which is a picture of good nutritional behavior .
LIMITATIONS OF STUDY
The study used purposive sampling due to poor road access to the research area.
This might cause less representative of the population Furthermore, dietary diversity score only counts the number of types of food groups consumed without considering the portion and amount eaten, so there is a possibility that the children consume a variety of foods but not in sufficient quantity.
CONCLUSIONS AND RECOMMENDATIONS
The prevalence of stunting in Pajangan District.
Bantul Regency.
Yogyakarta Province was 32.
5% children consumed diverse diet.
The results of the analysis showed that there was a significant relationship between dietary diversity and stunting .
=0.
OR=2.
95%CI= 1.
Strategy to improve dietary diversity on complementary feeding are needed to prevent However, maternal and paternal employment status played important role to increase dietary diversity by ensuring household income level.
High household income level will increase purchasing power and accessibility to diverse foods on complementary feeding.
REFERENCES